Non-disclosure or misrepresentation of information represents one of the most frequent reasons for claim rejection in health insurance. According to reports from NDTV Profit, this includes omitting pre-existing conditions, lifestyle diseases, or previous medical treatments during the policy purchase process. Many policyholders underestimate the importance of full disclosure, assuming minor details won't matter. In many cases, non-disclosure is not deliberate - policyholders often rely on agents or intermediaries to complete proposal forms, and important medical information may get omitted because the person filling the form is not fully aware of the proposer's health history. To avoid such situations, proposers should personally fill in, or at least carefully verify, all important health-related details before the proposal form is submitted.
Health insurance policies typically come with waiting periods for certain conditions, including pre-existing diseases, specific treatments, or maternity-related expenses. As reported by NDTV Profit, if a claim is made during this period, it is likely to be rejected. Many policyholders are unaware of these timelines or assume that all conditions are covered from day one. It is important to carefully read the policy document and understand the waiting periods applicable. Planning in time and maintaining continuity in coverage can help reduce such situations. For NRIs specifically, waiting periods for pre-existing diseases typically range from 24 to 48 months of continuous coverage, making it crucial to purchase policies early while still living abroad to complete these waiting periods.
Some health insurance policies may appear attractive because they are available at a lower premium, but such policies may include waiting periods, co-pay clauses, sub-limits or other conditions that may affect the claims experience later. According to NDTV Profit, rather than choosing a policy based only on cost, policyholders should carefully evaluate the product features. Understanding the coverage, waiting periods, co-pay requirements, sub-limits and exclusions before purchasing a policy can help avoid unpleasant surprises when a claim arises. A policy that best suits one's healthcare needs is often a better choice than one that simply costs less.
Lack of proper documentation is another common cause of claim rejection or delay, including missing hospital bills, prescriptions, discharge summaries, or diagnostic reports. In reimbursement claims especially, documentation plays a critical role in verifying the authenticity and necessity of treatment. As reported by NDTV Profit, policyholders should maintain all medical records carefully and ensure that they are submitted in the required format. Most insurers require timely intimation of hospitalisation or treatment, and delays in notifying the insurer or submitting claims beyond the stipulated period can lead to rejection. This is particularly relevant in reimbursement claims, where policyholders may not inform the insurer in advance. For NRIs, hospitalisation notifications must be made within 24 hours of emergency admission or 48 hours before planned surgery to ensure seamless claim processing.
Policyholders should remember that health insurers operate within a well-regulated framework and cannot reject claims without a justified reason. According to NDTV Profit, if a claim is believed to have been unfairly denied, established grievance redressal mechanisms, including the Insurance Ombudsman and consumer forums, are available to ensure a fair resolution. Many claim-related issues arise not because of intent, but due to gaps in awareness and understanding of policy terms. Reading the policy document carefully, asking questions before purchase, making complete disclosures, maintaining proper documentation and adhering to claim timelines can significantly improve the claims experience. The Insurance Regulatory and Development Authority of India (IRDAI) has streamlined the process for NRIs, allowing policies to be purchased online from the UAE without physical presence in India, provided KYC requirements are met using the NRI's passport and residency proof.
